Poisoning is a public health problem that affects all ages, with unintentional poisoning death primarily among young and middle aged adults and nonfatal injuries experienced most among young children. Regardless of age or extent of injury, the majority of unintentional poisonings occur in the home. [1] Most poisoning prevention efforts have been aimed at reducing poisoning of children; over the last decade the rate of child death due to unintentional poisoning has declined. [2] The only prevention effort shown to be effective has been mandating child resistant packaging of poisonous substances. [1] Much research still needs to be done to establish the effectiveness of other child poisoning prevention efforts and to develop better interventions for adult unintentional poisoning prevention.

Morbidity and mortality

Deaths

Unintentional poisoning is the second leading cause of unintentional home injury deaths in the United States with an average of 4,833 deaths annually. [1]

Just over half of all poisoning deaths occur in the home (50.6%). [1]

The majority of people who die from unintentional poisoning are young and middle age adults with the death rate for males three times that for females. [1]

Most unintentional poisoning deaths in the home are due to heroin (23.8%), appetite depressants (21.9%), and local anesthetics like cocaine (12.3%). Other major sources of unintentional poisoning deaths are from amphetamines, caffeine, antidepressants, alcohol, and motor vehicle exhaust gas. [1]

Injuries and Emergency Room Visits

Unlike poisoning deaths where adults have the highest rates, nonfatal poisoning rates are highest among children younger than 5. [1]

In 2002, more than 1.2 million unintentional poisonings among children ages 5 and under were reported to US Poison Control Centers. [2]

Children are most often poisoned by household and cleaning products, personal care and beauty products, medicines (iron containing medicines are among the most dangerous), vitamins, plants, lead and carbon monoxide. [1-4]

Poisonings are the ninth leading cause of home injuries resulting in an emergency room visit with an average of over 230,000 visits annually. [1]

On average, every 7 seconds a child age 5 and under arrives at an emergency room due to a suspected poisoning. [5]

Where and when the deaths and injuries occur

Approximately 90% of all poison exposures occur in the home. [2, 3, 6]

Calls to US Poison Control Centers peak between 4pm and 10pm and during warmer months. [2]

According to the American Academy of Pediatrics, most child poisonings occur when parents are not paying close attention, for example when cooking dinner. [4]

Populations at disproportionate risk

African American children ages 14 and under have a poisoning death rate more than one and a half times that of white children. [2]

Children ages 1 to 5 are more likely to have elevated blood lead levels if they are poor, or live in older housing. Children ages 1 to 5 enrolled in Medicaid have a prevalence of elevated blood lead levels three times greater than children not enrolled in Medicaid. [6]

Effectiveness of injury interventions

Since the passage of the Poison Prevention Packaging Act of 1970, child-resistant packaging has been the only prevention strategy that has been documented in the public health literature to have successfully reduced unintentional poisoning deaths and non-fatal injuries. [1, 7-12]

While not yet fully evaluated, other promising interventions include product reformulation, development and coordination of a national Poison Control Center network, and parental education. [2]

In 2005 the Management of Poisoning Consensus Panel concluded that the circumstances in which home use of Ipecac Syrup is the appropriate or desired response are rare. The panel does not support the routine stocking of ipecac in all households with young children. [13]

Cost and cost-effectiveness data

For every dollar spent on poison control services in 1992, an estimated $7 was saved in medical care payments by reducing the number of medically treated poisonings. The savings per poisoning call were $175. [6]

In 2001 injuries from poisonings in the home cost 22 billion dollars. [1]

From 1997-2001 poisonings were the third highest cause of medical care costs from unintentional home injuries, with an average annual cost of 18 billion dollars. [1]

References

1. Runyan, C. and C. Casteel, eds. The State of Home Safety in America: Facts About Unintentional Injuries in the Home. 2nd ed. 2004, Home Safety Council: Washington, DC.

13. Manoguerra, A., D. Cobaugh, and Guidelines for the Management of Poisoning Consensus Panel. Guidelines on the use of Ipecac Syrup in the out-of-hospital management of ingested poisons. Clinical Toxicology, 2005. 43: p. 1-10.